Precision medicine based treatment strategies in Inflammatory Bowel Disease with a focus on Therapeutic Drug Monitoring

Shields, Stephanie Anne (2025) Precision medicine based treatment strategies in Inflammatory Bowel Disease with a focus on Therapeutic Drug Monitoring. MD thesis, University of Glasgow.

Abstract

Background: The treatment landscape in Inflammatory Bowel Disease (IBD) has expanded rapidly in the last decade. Despite this, the rates of treatment failure for patients with the condition remains high. Precision medicine has been suggested as a strategy to improve patient care, by personalising treatment strategies to the individual and their disease, aiming to meet an agreed set of treatment targets. Therapeutic drug monitoring (TDM) for adalimumab and infliximab, measuring of serum drug levels and anti-drug antibodies, has emerged as a tool to aid precision medicine, but high quality research to support it is lacking. Traditionally TDM was performed reactively when a patient lost response to their treatment, but evidence for proactive monitoring when a patient is well to keep them in remission has emerged. The role of TDM at specific stages in treatment, for example, induction or maintenance of treatment, is also debated. The aim of this work was to explore precision medicine strategies for IBD, focusing on TDM strategies.

Methods: A structured literature search was conducted reviewing current TDM literature in the field. The Scottish TDM service was used to inform projects looking at uptake of TDM in Scotland and when to perform testing. The SERAFINA study evaluated serum and faecal infliximab TDM during the most severe stages of disease. Finally the EVALTDM was a large population based data study reviewing the impact of proactive TDM, reactive TDM and no TDM on clinical outcomes.

Results: A large quantity of TDM focused research exists evaluating its use in IBD, but the quality of the literature remains variable. In particular, the field lacks large, well powered, prospective studies. Despite this, TDM has been enthusiastically embraced by physicians in Scotland. The SERAFINA study suggested that serum TDM is less helpful in the most severe stages of disease, but that faecal infliximab may prove to be a useful biomarker. It also suggested that further work to review earlier accelerated dosing is required. The EVAL-TDM is one of the largest datasets in the field and demonstrated that proactive TDM is superior to reactive TDM to improve clinical outcomes for IBD patients.

Conclusion: Precision medicine is necessary to improve the outcomes of patients with IBD. At present TDM, and in particular proactive TDM, is the best tool at our disposal to aid precision medicine in IBD.

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Additional Information: Supported by funding from Biogen.
• Subjects: R Medicine > R Medicine (General); R Medicine > RM Therapeutics. Pharmacology
• Colleges/Schools: College of Medical Veterinary and Life Sciences
• Funder's Name: Biogen
• Supervisor's Name: MacDonald, Dr. Jonathan, Padmanabhan, Professor Sandosh and Guzik, Professor Tomasz
• Date of Award: 2025
• Depositing User: Theses Team
• Unique ID: glathesis:2025-85558
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 30 Oct 2025 16:09
• Last Modified: 30 Oct 2025 16:09
• Thesis DOI: 10.5525/gla.thesis.85558
• URI: https://theses.gla.ac.uk/id/eprint/85558

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